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RE: NRC Information Notice 2002-28/fluoroscopy
Although I appreciate your response very much, I need to reiterate that I
addressed only the BUSINESS of an RSO in taking care of the OCCUPATIONAL
exposures, versus patients' exposure that is under an MD's treatment and C A
R E !
That we discuss patient's exposures with MD's administering a procedure or
using a certain treatment modality, is COMMENDABLE and, most probably,
DESIRABLE, but, according to our MANDATE (either implicit or explicit), it
is NOT our BUSINESS (saying that, it does not mean at all, that we should
not DO something about it - your action is a fine, human and professional,
example).
COMPASSION, on the other hand, IS our PERSONAL business - I alluded to it in
the previous postings.
Furthermore, in the settings of our employment, it IS our business to
practice OCCUPATIONAL and GENERAL PUBLIC ALARA, but NOT the patients' - that
IS the MD's BUSINESS. Their compassion is, however, THEIR personal
business - whether we can do something about that is questionable, to say
the least. ALARA is NOT MANDATED for patients under any "radiation"
treatment (should it be and by whom?) - FOR OCCUPATIONAL and PUBLIC
EXPOSURE, it IS !
If the MD's, whom we are working along, accept our voice of concern, it is
superb. But not all, or, rather, seldom are MDs as receptive as your
colleagues, apparently, are, to suggestions from the "left fielders." Your
personal, professional, authority may be of help in your settings, but I
would be careful in approaching an MD and tell her or him that the patient
is being "fried." In such a case, would you jump in and turn the beam off
and, in your, NOT the doctor's, opinion, save the patient from being "burned
alive?"
That brings another concern, related, I think, to all radsafers, that I
wanted to bring up for some time - the application of the "Good Samaritan"
behavior and law. If not MDs, we, radsafers, are proscribed from "practicing
medicine" even in a grave situation of an accident. For example,
administering potassium iodide in a hypothetical case of an accidental,
massive 131-I intake (an MD is not available, for many hours, even to give
an advice) may be, quickly (think of lawyers), construed as an unauthorized
practicing of medicine. Is the Good Samaritan law applicable in this case? I
am not aware of any incident that treats such a situation (radsafer/Good
Samaritan), but it would be interesting to hear what others think of it - I
guess.
Regards - Dsuan Radosavljevic
Austin, TX
desegnac@swbell.net
-----Original Message-----
From: owner-radsafe@list.vanderbilt.edu
[mailto:owner-radsafe@list.vanderbilt.edu]On Behalf Of Tonry, Louie L MAJ
EAMC
Sent: Monday, October 07, 2002 5:35 AM
To: 'desegnac'
Cc: radsafe@list.vanderbilt.edu; Krivanek, David C Mr EAMC
Subject: RE: NRC Information Notice 2002-28/fluoroscopy
I totally disagree with you regarding these patient exposures. Our
jobs as RSOs is to maintain exposures ALARA. Although I do agree that we
can't nor shouldn't interfere with patient treatment, we MUST ensure our
education programs for physicians are weighted heavily on patient exposures.
Unless you have medical physicists on staff, which a lot of facilities
don't, our job in addition to providing radiation safety is to ensure image
quality and appropriate training. Personally, our facility doesn't have a
medical physicist and I'm deeply involved in ensuring image quality with all
users of x-ray equipment. If I observe a physician, and I often watch
cases, that is overly heavy on the pedal, I will talk with them about
patient exposure, using pulsed fluoro and other techniques to minimize
exposures to their patients. I am usually received well. In general
physicians are not aware of the significant exposures they're delivering and
appreciate the information.
At my facility I attempt, within the constraints of my staffing, to
provide radiation safety to everyone affected including staff, the general
public, AND THE PATIENTS.
Louie Tonry, CHP
Eisenhower Army Medical Center
Ft. Gordon GA
-----Original Message-----
From: desegnac [mailto:desegnac@SWBELL.NET]
Sent: Friday, October 04, 2002 3:28 PM
To: Jacobus, John (NIH/OD/ORS); 'RadSafe'
Subject: RE: NRC Information Notice 2002-28/fluoroscopy
Re: NRC-fluoroscopy-overexposure
If I am not mistaken, we are missing the target. OCCUPATIONAL EXPOSURES is
an NRC-Agreement State business, thus RSO's domain, while exposure of
patients is exempted from regulations, thus irrelevant. That is, an RSO's
business is to secure that the exposures of those who are required to wear
personal dosimetry badges, are within the occupational limits. That is why
NRC says that there shall be a functional RSO. Patients' exposure is, as of
now, between a doctor, patient and their God.
Dusan Radosavljevic
Austin, TX
desegnac@swbell.net
-----Original Message-----
From: owner-radsafe@list.vanderbilt.edu
[mailto:owner-radsafe@list.vanderbilt.edu]On Behalf Of Jacobus, John
(NIH/OD/ORS)
Sent: Friday, October 04, 2002 12:15 PM
To: 'RadSafe'
Subject: RE: NRC Information Notice 2002-28/fluoroscopy
Mike,
Gary is partly correct in that a lot of overexposures was due to poor
training of the physicians with regard to the risk of skin exposures. (Of
course, in some situations, the patients presented difficult cases, and in
some repeat exams.)
There is interest paper and really nasty case shown in paper that can be
found at
http://ojps.aip.org/journals/doc/JACMFG-home/top5.jsp
Enter the search item as: protecting patients by training
Set the search field: TITLE
If that does not work, let me know and I will send a copy of the article as
a pdf file.
Have a good weekend.
-- John
John Jacobus, MS
Certified Health Physicist
3050 Traymore Lane
Bowie, MD 20715-2024
E-mail: jenday1@email.msn.com (H)
-----Original Message-----
From: Michael G. Stabin [mailto:michael.g.stabin@vanderbilt.edu]
Sent: Friday, October 04, 2002 12:02 PM
To: Gary Isenhower
Cc: William V Lipton; radsafe; carmine_mhp@YAHOO.COM
Subject: Re: NRC Information Notice 2002-28/fluoroscopy
. . .
> It is true that some overexposures occur due to lack of experience in the
physician
> performing the procedure.
I thought a big part was due to the fact that there is poor "live time"
knowledge of the cumulative dose.
. . .
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